Development of Internal Carotid Artery Dissection During Masturbation.

Sexual intercourse is known as one of the daily activities triggering spontaneous cervicocephalic artery dissection (sCAD), however, it has been unclear if masturbation can trigger the development of sCAD. Herein, we report a case of sCAD in association with masturbation. A 51-year-old right-handed man developed subarachnoid hemorrhage during masturbation. The dissection of the left internal carotid artery was evident on the 9th hospital day. Finally, he was treated with stenting and coiling and discharged with a good prognosis.

[Surgical repair of the tunica albuginea for penis fracture: Selection of incision].

OBJECTIVE: To investigate the diagnosis and management of penile fracture. METHODS: From June 1993 to May 2017, 46 cases of penile fracture were treated in our hospital, averaging 33.5 (25－42) years of age and 3.45 (1－10) hours in duration, of which 41 occurred during sexual intercourse, 4 during masturbation and 1 during prone sleeping, 4 with hematuria, but none with dysuria or urethral bleeding. Hematoma was confined to the penis. Emergency surgical repair was performed for all the patients, 45 under spinal anesthesia and 1 under local anesthesia, 16 by coronal proximal circular incision and the other 30 by local longitudinal incision according to the rupture location on ultrasonogram. The tunica albuginea ruptures averaged 1.31 (0.5－2.5) cm in length, which were sutured in the "8" pattern for 6 cases and with the 3－0 absorbable thread for 18 cases. The skin graft or negative pressure drainage tube was routinely placed, catheters indwelt, and gauze used for early pressure dressing. In the recent few years, elastic bandages were employed for 3－5 days of pressure dressing and antibiotics administered to prevent infection. The stitches and catheter were removed at 7 days after surgery. RESULTS: Short-term postoperative foreskin edema occurred in 14 of the 16 cases of circular degloving incision, but no postoperative complications were observed in any of the cases of local incision. Twenty-eight of the patients completed a long-term follow-up of 49.4 (10－125) months, which revealed good erectile function, painless erection, and satisfactory sexual intercourse. CONCLUSIONS: For most penile fractures, local longitudinal incision is sufficient for successful repair of the tunica albuginea, with mild injury, no influence on the blood supply or lymph reflux, and a low rate complications. It therefore is obviously advantageous over circular degloving incision except when the cavernous body of urethra is to be explored, which necessitates circular degloving incision below the coronal groove.

Knotted electric wire in urinary bladder: Can such complex foreign body be retrieved endoscopically!

Various types of foreign bodies have been recovered from the urinary bladder and urethra including telephone cables, pocket battery, little fish, pen tips and so on. Management of such cases include either endoscopic removal or open surgery. We report the case of an 18-year-old boy who inserted an electric wire in the urethra for eroticism and was managed by endoscopic removal following fragmentation of wire under local anaesthesia using holmium laser.

Sexual Activity as a Risk Factor for the Spontaneous Rupture of Cerebral Aneurysms.

Subarachnoid hemorrhages from ruptured cerebral aneurysms have a high clinical relevance and often lead to death. Approximately 2% to 5% of the people worldwide, even of younger age, are said to have aneurysms at cerebral arteries. In many cases, they remain clinically unapparent for decades. However, there are numerous risk factors for the rupture of an aneurysm, including temporary raises of the blood pressure. Such changes of the blood pressure can be induced even by several everyday behaviors. For example, any sort of sexual activities may cause extensive raises of the blood pressure because of several physical and psychological factors. The term "sexual activity" covers sexual intercourse as well as masturbation. In this article, the remarkable case of a 24-year-old woman with a ruptured cerebral aneurysm in the context of masturbation is presented. It is discussed with respect to the possible pathophysiological effects of sexual activity on cerebral aneurysms.

Natural death in the setting of autoerotic practice.

Deaths in an autoerotic setting are usually due to accidental asphyxia, in which the individual accidently hangs or strangles themselves while inducing hypoxia for the purpose of heightened arousal. Death occurs when the level of hypoxia causes the individual to lose consciousness and is thus unable to prevent the neck compression from becoming lethal. In some cases there is an "escape" mechanism incorporated into the set-up which may fail. In rare cases, death is not as an immediate result of the autoerotic activity and is as a result of natural causes, which may or may not be related to the process. This case demonstrates the death of a 69 year old male which has occurred in the setting of a complex autoerotic environment, not as a result of asphyxiation, but rather as a result of natural causes which is likely to have been brought about by repeated similar activity. The autopsy revealed pulmonary emboli and lower limb deep vein thrombosis. There was no other natural disease of note and no features considered typical of asphyxiation.

Long-term outcome of infantile gratification phenomena.

BACKGROUND: Infantile gratification phenomena are self-stimulatory behaviors that are often misdiagnosed as epilepsy. Although the prognosis is thought to be benign, limited long-term follow-up studies exist. This was the objective of our study in addition to exploring the risks of future developmental, behavioral, or neurological abnormalities. METHODS: Series of consecutive infants with gratification phenomena were identified both retrospectively and prospectively over an eight year period from a single pediatric neurology service. The diagnosis was based on descriptive history, review of videotaped events, lack of neurological or developmental abnormalities, and normal routine electroencephalogram. RESULTS: Nineteen infants were followed for 3-11 years (mean 7.1). Their ages ranged between 4-13 months (mean 7) with 79% females. The diagnosis was not reached by the referring physician and 74% were misdiagnosed as epilepsy or movement disorder. The episodes recurred with variable frequency with gradual reduction in number and increase in length of attack-free periods with advancing age. Complete remission was noted in all patients by age 1-3 years (mean 1.9). However, 4 children (21%) developed features of attention deficit hyperactivity disorders (ADHD) on long-term follow up. In this group, the gratification phenomena appeared at a younger age with higher attack frequency. CONCLUSIONS: Gratification phenomena in infants are benign and self-limited, often spontaneously disappearing by two years of age. A correlation with future ADHD was found; however, larger prospective studies are needed to further examine this possible association.

Epilepsia refleja cinetogénica asociada a movimientos masturbatorios / Kinetogenic reflex epilepsy associated to masturbatory movements

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¿Existe realmente la adicción al sexo? / Does really sex addiction exist?

Resulta importante conocer qué factores de personalidad se asocian con la adicción para poder distinguir a los adictos que requieren un tratamiento especializado de quienes no llegan a necesitarlo, así como diferenciar a los que consiguen la abstinencia de quienes persisten en el consumo a pesar de las consecuencias negativas. El modelo de Cloninger incluye variables biológicas y psicosociales que pueden ser caracterizadas en términos neuropsicológicos. Se analizaron dos muestras, una de sujetos con adicción a cocaína que iniciaban tratamiento (n=183) y otra de población no-clínica (n=183), equiparadas en sexo, edad y nivel académico. Se controló el abuso/dependencia de alcohol como variable independiente. Se apreciaron diferencias significativas y con gran tamaño del efecto entre los adictos y la población no-clínica en Búsqueda de Novedad y Autodirección, y con menor magnitud, en Evitación del Daño. Estas diferencias se incrementan cuando existe consumo problemático de alcohol añadido. Se establecieron los subgrupos de adictos (clusters) según el perfil de rasgos y se obtuvieron las diferencias en variables como impulsividad funcional/disfuncional, sintomatología disejecutiva y estrés percibido. Se identificaron 6 subgrupos, algunos de poca gravedad, caracterizándose los más graves por mayores niveles de impulsividad disfuncional, más sintomatología disejecutiva y mayores niveles de estrés percibido. La Autodirección parece reflejar el déficit de los sistemas prefrontales en la regulación de la conducta, así como en el control emocional y de los impulsos. Se sugiere la evaluación de la personalidad como herramienta más útil que la mera evaluación de síntomas para clasificar a los adictos, determinar sus necesidades y trazar un itinerario terapéutico(AU)

It is important to know which personality factors are associated with addiction so to distinguish addicts that require specialized treatment from those who do not, and to identify those addicts who achieve abstinence from those who continue their substance use despite the negative consequences. Cloninger’s model includes biological and psychosocial variables that can be characterized in neuropsychological terms. Two samples were analyzed: individuals who had begun cocaine addiction treatment (n=183) and a non-clinical population sample (n = 183), matched for sex, age and educational level. Alcohol abuse/dependence was monitored as an independent variable. Significant differences and large effect size were found between addicts and non-clinical population in Novelty Seeking and Self-Directedness, and to a lesser extent, in Harm Avoidance. These differences increase when problematic use of alcohol is added. According to the profile of traits, clusters of addicts were established and differences were obtained in variables such as functional/dysfunctional impulsivity, dysexecutive symptoms and perceived stress. Six clusters were identified, some of minor severity, the most severely problematic clusters being characterized by higher levels of dysfunctional impulsivity, more dysexecutive symptoms and higher levels of perceived stress. Self-Directedness seems to reflect the deficit of prefrontal systems in the regulation of behavior, as well as in emotion and impulse control. It is proposed that evaluation of the personality is more useful than the mere assessment of symptoms for classifying addicts, determining their needs and designing a therapeutic itinerary(AU)

Compulsive masturbation and chronic penile lymphedema.

Chronic penile lymphedema arises from the abnormal retention of lymphatic fluid in the subcutaneous tissues and may be secondary to local and systemic medical conditions such as sexually transmitted diseases, filariasis, malignancy, local radiotherapy, and surgery. This case report aims to consider compulsive masturbation as a possible cause of chronic penile edema. A 40-year-old man was referred to our institute for behavioral disturbance, including compulsive masturbation. Neuropsychiatric evaluation showed moderate mental retardation, mild dysarthria and limb incoordination, anxiety, depressed mood, and impulse dyscontrol. Brain MRI pointed out diffuse white matter lesions. Urogenital examination revealed an uncircumcised penis with non-tender edema of the shaft and prepuce with areas of lichenification. Since the most common local and systemic causes of edema were excluded, chronic penile edema due to compulsive masturbation was diagnosed and the compulsive behavior treated with an antidepressant and low-dose neuroleptics. Compulsive masturbation should be taken into account when counselling patients with penile edema.

Asfixia autoerótica: La escena de la muerte / Autoerotic asphyxia. The scene of the death

En números anteriores de nuestra revista se han tratado, con profusión de imágenes, las asfixias mecánicas; tanto en su aspecto macroscópico, como microscópico. Hoy mostramos una ahorcadura, atípica hasta hace escaso tiempo en nuestro medio, la "asfixia autoerótica". El diagnóstico de la naturaleza de la muerte (accidental, suicida e incluso homicida) ha sido muy discutido, teniendo un papel fundamental en su aclaración, la Diligencia de Levantamiento de Cadáver. Un examen meticuloso del lugar de los hechos nos va a orientar de manera definitiva sobre la naturaleza del óbito (AU)

In previous numbers of our magazine one has treated, with profusion of images, the asphyxiations mechanics; so much in their macroscopic aspect, as microscopic. Today we show a hanging, atypical up to scanty time ago in our way, the "autoerotic asphyxiation". The diagnosis of the nature of the death (accidental, suicidal and enclosed killer) has been very controversial, having a fundamental role in his explanation the scene of the death. A meticulous examination of the place of the facts is going to orientate us in a definitive way on the nature of the death (AU)

Long-term outcome of surgical treatment of penile fracture complicated by urethral rupture.

INTRODUCTION: The combination of lesions of the penile urethra and the corpus cavernosum is rare and is likely to worsen the immediate and long-term prognosis. AIM: To assess the late effects of penile fractures complicated by urethral rupture treated by immediate surgical intervention. METHODS: Fourteen patients with concomitant urethral rupture were treated surgically at our center. Those patients were seen in the outpatient follow-up clinic and were re-evaluated. MAIN OUTCOME MEASURES: Sexual Health Inventory for Men questionnaire, local examination, uroflowmetry and penile color Doppler ultrasound. RESULTS: The most common cause of penile fracture is sexual intercourse (50%). The site of tunical tear was in the proximal shaft of the penis in 3 patients (21%) and in the mid of the shaft in 11 patients (79%). Urethral injury was localized at the same level as the corpus cavernosum tear in all cases; and it was partial in 11 cases and complete in 3. Long-term follow-up (mean=90 months) was available for 12 patients; among whom there was no complications in 4 (33%), painful erection in 1 (8%), erectile dysfunction in 2 (17%), and palpable fibrous nodule in 5 (47%). All patients had a normal urinary flow except one who developed relative urethral narrowing that required regular dilatation for 1 month. CONCLUSIONS: The urethral injury complicating penile fracture is often partial and localized at the level of the corpora cavenosa tear. Standard treatment consists of immediate surgical repair of both urethral and corporal ruptures with no harmful long-term sequelae on urethral and erectile function in most of patients.

Sexual headache in young adolescence: a case report.

We present the case of a boy who first experienced typical primary headache associated with sexual activity, orgasmic type, at age 12. Neurological examination and brain imaging were normal. A family history of migraine existed. The case shows the broad age spectrum of this primary headache disorder.

Sexual activity and prostate cancer risk in men diagnosed at a younger age.

OBJECTIVE: To examine, in a case-control study, the association between the frequency of sexual activity (intercourse, masturbation, overall) and prostate cancer risk in younger men diagnosed at < or = 60 years old. PATIENTS, SUBJECTS AND METHODS: In all, 431 prostate cancer cases and 409 controls participated and provided information on their sexual activity. In particular, the frequencies of intercourse and masturbation during the participants' different age decades (20s, 30s, 40s, 50s) were collected. RESULTS: Whereas frequent overall sexual activity in younger life (20s) increased the disease risk, it appeared to be protective against the disease when older (50s). Alone, frequent masturbation activity was a marker for increased risk in the 20s and 30s but appeared to be associated with a decreased risk in the 50s, while intercourse activity alone was not associated with the disease. CONCLUSION: These findings could imply different mechanisms by which sexual activity is involved in the aetiology of prostate cancer at different ages. Alternatively, there is a possibility of reverse causation in explaining part of the protective effect seen for men in their 50s.